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From the Road: Medical Billing May Not Be Enough

By: Dave Jakielo, CHBME

Most of us have considered ourselves to be in the Medical Billing Industry for many years, and for decades that has been sufficient. However, now that healthcare is evolving and changing at such a rapid pace, it is probably not enough to just offer "Billing Services" and expect to be a viable company in the future.

The traditional billing services we have offered are becoming more and more automated, such as:

• Eligibility Inquiries 270-271
• Intelligent Claim Scrubbing Programs
• Claim Status 276-277
• Authorization/Certification 278
• Claims and Payments 835-837

Given these advances, we now need to move from being known primarily as "Billing Experts" to being recognized as "Management and Billing Experts." Another way of looking at it is that we need to turn the data our clients entrust us with into information that will benefit their practices.

Clients are always complaining about declining reimbursements.  Ask yourself "How am I helping them increase revenue or control their cost?" It's unlikely that reimbursement will increase, so the only options they have if they don't want to experience erosion in their take home pay are to offer more profitable services or reduce costs.

Your company should help your clients address both of these areas. Have you ever done a cost analysis for your clients to determine what it "actually" costs them to deliver each of the procedures they provide to their patients? If you haven't, I guarantee you they have overpriced services, breakeven services, and services that are costing them money to deliver.

Once you have gone through the costing exercise, then you can review the payment schedules from each payer they participate with to see what services may need renegotiated or who they may need to drop altogether.

Here is an example of an area where you can turn data into valuable information: try compiling and examining referring physician data. It's not enough to know which doctor is sending your client the most patients, but more importantly who is sending them the profitable patients.

I once knew a doctor who always went out of his way to squeeze in patients from his friend who sent him a high volume of referrals. He would stay late if necessary because he didn't want to disappoint his high-referring friend. However, upon examining the data, it was found that of the patients he was referring to my client, all had the same low-paying coverage.

I called the referring doctor's office to ask how they could have a sustainable practice by only seeing patients with this low-paying coverage and the person I spoke to said, "We don't only see patients with that coverage." So I asked why all the referrals we received from their office always had that coverage and she responded, "Oh, patients with that coverage are always referred to his brother-in-law's practice."

The above is just one example of how you could make yourself more valuable to your clients. 

A few other examples are:

• Provide feedback on how well their staff is collecting copays and deductibles. Not only does this improve the practice's cash flow, but it reduces your patient billing and collecting costs.
• Prepare E&M coding comparison charts showing each individual provider in the practice. I have seen an instance where one doctor only billed a level 3 for every patient, thinking that would protect him from ever getting audited and he reasoned that using a 3 for every patient would balance things out in the long run. What a compliance nightmare for the practice and the billing company.
• Examining the patient cancellation report can lead to some interesting patterns and findings. One practice I was working with discovered that a majority of their cancellations, although sporadic, occurred at the end of the day. What was later discovered was that the doctor would run behind schedule on the days he made rounds at the nursing home before office hours. This would cause the staff to have to stay later by an hour or more to get through the schedule. So if anyone on the staff had a commitment the evening of a nursing home day, they would simply fill the schedule with fictitious patients in the afternoon to ensure they could get out on time.

These are just a few examples of how you can become extremely valuable to your clients. Doing "billing," while extremely important, isn't enough in today's challenging environment. Remember: it's not the data; it's the information that will make you indispensable to your clients.

Dave Jakielo, CHBME, is an International Speaker, Consultant, Executive Coach, and Author, and is President of Seminars & Consulting. Dave has been helping Companies grow and improve their profitability for over 4 Decades. Sign up for his FREE weekly Success Tips at www.Davespeaks.com. Dave can be reached via email Dave@Davespeaks.com; phone 412-921-0976.